Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

SCREW CANNULATED LAG, 4.5MM X 38MM

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047198
Hospital Revenue Code	278
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$77.87
Rate for Payer: Amerigroup Medicare	$61.36
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$60.75
Rate for Payer: Iowa Total Care Managed Medicaid	$77.11
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$60.75
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$78.25
Rate for Payer: Partners Health Alliance Commercial	$69.86
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

SCREW CANNULATED LAG, 4.5MM X 38MM-FT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047197
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

SCREW CANNULATED LAG, 4.5MM X 38MM-FT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047197
Hospital Revenue Code	278
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$77.87
Rate for Payer: Amerigroup Medicare	$61.36
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$60.75
Rate for Payer: Iowa Total Care Managed Medicaid	$77.11
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$60.75
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$78.25
Rate for Payer: Partners Health Alliance Commercial	$69.86
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

SCREW CANNULATED LAG, 4.5MM X 40MM-FT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047199
Hospital Revenue Code	278
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$77.87
Rate for Payer: Amerigroup Medicare	$61.36
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$60.75
Rate for Payer: Iowa Total Care Managed Medicaid	$77.11
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$60.75
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$78.25
Rate for Payer: Partners Health Alliance Commercial	$69.86
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

SCREW CANNULATED LAG, 4.5MM X 40MM-FT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047199
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

SCREW CANNULATED LAG, 4.5MM X 40MM-PT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047200
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

SCREW CANNULATED LAG, 4.5MM X 40MM-PT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047200
Hospital Revenue Code	278
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$77.87
Rate for Payer: Amerigroup Medicare	$61.36
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$60.75
Rate for Payer: Iowa Total Care Managed Medicaid	$77.11
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$60.75
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$78.25
Rate for Payer: Partners Health Alliance Commercial	$69.86
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

SCREW CANNULATED LAG, 4.5MM X 45MM-FT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047201
Hospital Revenue Code	278
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$77.87
Rate for Payer: Amerigroup Medicare	$61.36
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$60.75
Rate for Payer: Iowa Total Care Managed Medicaid	$77.11
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$60.75
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$78.25
Rate for Payer: Partners Health Alliance Commercial	$69.86
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

SCREW CANNULATED LAG, 4.5MM X 45MM-FT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047201
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

SCREW CANNULATED LAG, 4.5MM X 45MM-PT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047202
Hospital Revenue Code	278
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$77.87
Rate for Payer: Amerigroup Medicare	$61.36
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$60.75
Rate for Payer: Iowa Total Care Managed Medicaid	$77.11
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$60.75
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$78.25
Rate for Payer: Partners Health Alliance Commercial	$69.86
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

SCREW CANNULATED LAG, 4.5MM X 45MM-PT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047202
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

SCREW CANNULATED LAG, 4.5MM X 50MM-FT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047203
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

SCREW CANNULATED LAG, 4.5MM X 50MM-FT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047203
Hospital Revenue Code	278
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$77.87
Rate for Payer: Amerigroup Medicare	$61.36
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$60.75
Rate for Payer: Iowa Total Care Managed Medicaid	$77.11
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$60.75
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$78.25
Rate for Payer: Partners Health Alliance Commercial	$69.86
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

SCREW CANNULATED LAG, 4.5MM X 50MM-PT

Facility

$270.00

Service Code	HCPCS C1713
Hospital Charge Code	8047204
Hospital Revenue Code	278
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: United Healthcare Commercial	$243.00

SCREW CANNULATED LAG, 4.5MM X 50MM-PT

Facility

$270.00

Service Code	HCPCS C1713
Hospital Charge Code	8047204
Hospital Revenue Code	278
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Aetna of IA Medicare	$153.90
Rate for Payer: Amerigroup Medicaid	$155.74
Rate for Payer: Amerigroup Medicare	$122.72
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$121.50
Rate for Payer: Iowa Total Care Managed Medicaid	$154.22
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Medical Associates Managed Medicare	$121.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: Molina Healthcare Managed Medicaid	$156.49
Rate for Payer: Partners Health Alliance Commercial	$139.72
Rate for Payer: United Healthcare Commercial	$243.00
Rate for Payer: United Healthcare Managed Medicare	$159.30

SCREW CANNULATED LAG, 4.5MM X 55MM-FT

Facility

$270.00

Service Code	HCPCS C1713
Hospital Charge Code	8047205
Hospital Revenue Code	278
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Aetna of IA Medicare	$153.90
Rate for Payer: Amerigroup Medicaid	$155.74
Rate for Payer: Amerigroup Medicare	$122.72
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$121.50
Rate for Payer: Iowa Total Care Managed Medicaid	$154.22
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Medical Associates Managed Medicare	$121.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: Molina Healthcare Managed Medicaid	$156.49
Rate for Payer: Partners Health Alliance Commercial	$139.72
Rate for Payer: United Healthcare Commercial	$243.00
Rate for Payer: United Healthcare Managed Medicare	$159.30

SCREW CANNULATED LAG, 4.5MM X 55MM-FT

Facility

$270.00

Service Code	HCPCS C1713
Hospital Charge Code	8047205
Hospital Revenue Code	278
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna of IA Commercial	$243.00
Rate for Payer: Aetna of IA Medical Rental Products	$243.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$202.50
Rate for Payer: Medical Associates Commercial	$202.50
Rate for Payer: Midlands Choice Commercial	$189.00
Rate for Payer: United Healthcare Commercial	$243.00

SCREW CANNULATED LAG, 4.5MM X 55MM-PT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047206
Hospital Revenue Code	278
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$77.87
Rate for Payer: Amerigroup Medicare	$61.36
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$60.75
Rate for Payer: Iowa Total Care Managed Medicaid	$77.11
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$60.75
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$78.25
Rate for Payer: Partners Health Alliance Commercial	$69.86
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

SCREW CANNULATED LAG, 4.5MM X 55MM-PT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047206
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

SCREW CANNULATED LAG, 4.5MM X 60MM-FT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047207
Hospital Revenue Code	278
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$77.87
Rate for Payer: Amerigroup Medicare	$61.36
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$60.75
Rate for Payer: Iowa Total Care Managed Medicaid	$77.11
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$60.75
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$78.25
Rate for Payer: Partners Health Alliance Commercial	$69.86
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

SCREW CANNULATED LAG, 4.5MM X 60MM-FT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047207
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

SCREW CANNULATED LAG, 4.5MM X 60MM-PT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047208
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

SCREW CANNULATED LAG, 4.5MM X 60MM-PT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047208
Hospital Revenue Code	278
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$77.87
Rate for Payer: Amerigroup Medicare	$61.36
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$60.75
Rate for Payer: Iowa Total Care Managed Medicaid	$77.11
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$60.75
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$78.25
Rate for Payer: Partners Health Alliance Commercial	$69.86
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

SCREW CANNULATED LAG, 4.5MM X 65MM-FT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047209
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: United Healthcare Commercial	$121.50

SCREW CANNULATED LAG, 4.5MM X 65MM-FT

Facility

$135.00

Service Code	HCPCS C1713
Hospital Charge Code	8047209
Hospital Revenue Code	278
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of IA Commercial	$121.50
Rate for Payer: Aetna of IA Medical Rental Products	$121.50
Rate for Payer: Aetna of IA Medicare	$76.95
Rate for Payer: Amerigroup Medicaid	$77.87
Rate for Payer: Amerigroup Medicare	$61.36
Rate for Payer: Cash Price	$108.00
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$101.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$60.75
Rate for Payer: Iowa Total Care Managed Medicaid	$77.11
Rate for Payer: Medical Associates Commercial	$101.25
Rate for Payer: Medical Associates Managed Medicare	$60.75
Rate for Payer: Midlands Choice Commercial	$94.50
Rate for Payer: Molina Healthcare Managed Medicaid	$78.25
Rate for Payer: Partners Health Alliance Commercial	$69.86
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Managed Medicare	$79.65

Know your out-of-pocket cost for care.

All Charges